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General NPI Number Information
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NPI Number | 1992377766
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Entity Type | Individual
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Provider Name | SHEJIN AMBANATTU BABU
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Gender | Male
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 4000 PRESTON RD
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City | PLANO
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State | TX
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Zip | 75093-7301
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Country | US
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Telephone | 972-964-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 15513 RENSHAW WAY
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City | FRISCO
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State | TX
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Zip | 75036-7608
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Country | US
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Telephone | 972-900-0884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 68488
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License Number State | TX
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